Term pregnant patients have similar gastric volume to non-pregnant females: a single-centre cohort study.

BACKGROUND: The physiological changes of pregnancy can increase the risk of peri-partum pulmonary aspiration. There is limited objective information regarding gastric volumes in pregnant patients. The aim of this cohort study was to characterise prospectively the range of gastric-fluid volume in term non-labouring pregnant patients compared with a historical cohort of non-pregnant females. METHODS: Fasted non-labouring term pregnant patients scheduled for elective Caesarean delivery underwent a standardised gastric ultrasound examination. Gastric content was evaluated qualitatively (type of content), semi-quantitatively (Perlas grades), and quantitatively (volume). The antral cross-sectional area and volume were compared with those of a retrospective cohort of non-pregnant females from the same institution. Descriptive statistics were used to describe the central tendency through mean and median values. Dispersion was evaluated with standard deviation and inter-quartile range, and the higher end of the distribution as 95th percentile. RESULTS: Non-labouring pregnant (59) and non-pregnant (81) subjects were studied. The range of estimated total gastric-fluid volume (P=0.96) and volume per body weight (P=0.78) was not significantly different between cohorts. An estimated volume of 115 ml (102-143) vs 136 ml (106-149) and volume per body weight of 1.4 ml kg-1 (1.2-2.8) vs 2.0 ml kg-1 (1.5-2.7) corresponded to the 95th percentile (95% confidence interval) values in the pregnant and non-pregnant cohort, respectively. CONCLUSIONS: Baseline gastric volume of non-labouring pregnant patients at term is not significantly different from that of non-pregnant females. This information will be helpful to interpreting findings of gastric point-of-care ultrasound in obstetric patients.

Preoperative Assessment of Ultrasonographic Measurement of Antral Area for Gastric Content.

BACKGROUND Pulmonary aspiration of the gastric contents is a serious perioperative complication. The aim of this study was to evaluate the efficacy of portable ultrasonography in the preoperative evaluation of the gastric contents of patients. The secondary aim was to examine the relationship between gastric antrum cross-sectional area and age and body mass index (BMI). MATERIAL AND METHODS This single-center, prospective, cross-sectional study included 120 patients who underwent surgery. Measurements the gastric antral cross-sectional areas and quantitative and qualitative measurements of the stomach were taken by ultrasonography guidance in all patients. RESULTS With the patient in a supine position, the mean gastric antrum cross-sectional area was found to be 3.4±2.43 cm² (range, 0.79-17.3 cm²). As the number of hours of fasting increased, the gastric antral cross-sectional area statistically significantly decreased (P<0.05). Increased age and BMI values were determined to increase the gastric antrum cross-sectional area in a linear correlation; r=0.209, P<0.05 and r=0.252, P=0.05, respectively. It was determined that 20.8% of the patients exceeded the high-risk stomach antral cutoff cross-sectional area that was defined as 340 mm2 in patients fasting for at least 8 hours. CONCLUSIONS It was determined that bedside ultrasonography is a useful, non-invasive tool in the determination of gastric content and volume. A significant proportion of surgical patients may not present with an empty stomach despite the recommended fasting protocols.

Gastric ultrasound in the third trimester of pregnancy: a randomised controlled trial to develop a predictive model of volume assessment.

Bedside gastric ultrasonography can be performed reliably by anaesthetists to assess gastric content in the peri-operative period. We aimed to study the relationship between gastric cross-sectional area, assessed by ultrasound, and volumes of clear fluids ingested by pregnant women. We recruited 60 non-labouring third-trimester pregnant women in a randomised controlled and assessor-blinded study. A standardised scanning protocol of the gastric antrum was performed in the 45° semirecumbent and 45° semirecumbent-right lateral positions. Subjects were randomly allocated to drink one out of six predetermined volumes of apple juice (0 ml, 50 ml, 100 ml, 200 ml, 300 ml, 400 ml). Qualitative and quantitative assessments at a baseline period after an 8-h fast, and immediately after the drink, were used to establish the correlation between antral cross-sectional area and volume ingested. A predictive model to estimate gastric volume was developed. Antral cross-sectional area in the semirecumbent right lateral position significantly correlated with the ingested volume (Spearman rank correlation = 0.7; p < 0.0001). A cut-off value of 9.6 cm2 discriminated ingested volumes ≥ 1.5 ml.kg-1 with a sensitivity of 80%, a specificity of 66.7%, and an area under the curve of 0.82. A linear predictive model was developed for gastric volume based only on antral cross-sectional area (Volume (ml) = -327.1 + 215.2 × log (cross-sectional area) (cm2 )). We conclude that in pregnant women in the third trimester of gestation, the antral cross-sectional area correlates well with volumes ingested, and this cut-off value in the semirecumbent right lateral position discriminates high gastric volumes.

Changes in qualitative and quantitative ultrasound assessment of the gastric antrum before and after elective caesarean section in term pregnant women: a prospective cohort study.

Ultrasound measurement of the antral cross-sectional area allows a quantitative estimate of gastric contents in non-pregnant adults, but this relationship may be affected by compression of the stomach exerted by the gravid uterus during pregnancy. This study aimed to assess differences in quantitative (Perlas score) and qualitative (antral cross-sectional area) ultrasound assessments of the gastric antrum performed immediately before and after caesarean section. Forty-three women having elective caesarean section performed under spinal anaesthesia were studied in the semirecumbent and semirecumbent-right lateral positions. Thirty-nine women showed no change in stomach contents using the Perlas score between the two measurement periods; four women showed a change, but by one grade only. The median (IQR [range]) antral cross-sectional area was 323 (243-495 [103-908]) mm2 before, and 237 (165-377 [112-762]) mm2 after, caesarean section in the semirecumbent position (p = 0.001); the comparable values in the semirecumbent-right lateral position were 418 (310-640 [161-1238]) mm2 and 362 (280-491 [137-1231]) mm2 (p = 0.09). The distance between the skin and the antrum, and the aorta and the antrum, decreased significantly in both positions after surgery. We suggest that our results indicate that stomach contents remain largely unchanged in women having elective caesarean section, but antral cross-sectional area decreases, especially in the semirecumbent position, related to a change in the position of the stomach within the abdomen. This implies that the relationship of antral cross-sectional area to volume of stomach contents, which has been determined for non-pregnant subjects, may not apply in term pregnant women.

Gut morphology and hepatic oxidative status of European sea bass (Dicentrarchus labrax) juveniles fed plant feedstuffs or fishmeal-based diets supplemented with short-chain fructo-oligosaccharides and xylo-oligosaccharides.

The effects of short-chain fructo-oligosaccharides (scFOS) and xylo-oligosaccharides (XOS) on gut morphology and hepatic oxidative status were studied in European sea bass juveniles weighing 60 g. Fish were fed diets including fishmeal (FM diets) or plant feedstuffs (PF diets; 30 FM:70 PF) as main protein sources (control diets). Four other diets were formulated similar to the control diets but including 1 % scFOS or 1 % XOS. At the end of the trial, fish fed PF-based diets presented histomorphological alterations in the distal intestine, whereas only transient alterations were observed in the pyloric caeca. Comparatively to fish fed FM-based diets, fish fed PF diets had higher liver lipid peroxidation (LPO), superoxide dismutase (SOD) and catalase (CAT) activities, and lower glutathione peroxidase, glutathione reductase and glucose 6-phosphate dehydrogenase activities. In fish fed the PF diets, prebiotic supplementation decreased SOD activity and XOS supplementation further decreased CAT activity. In fish fed the FM diets, XOS supplementation promoted a reduction of all antioxidant enzyme activities. Overall, dietary XOS and scFOS supplementation had only minor effects on gut morphology or LPO levels. However, dietary XOS reduced antioxidant enzymatic activity in both PF and FM diets, which indicate a positive effect on reduction of hepatic reactive oxygen species production.

Effects of varying the inter-meal interval on relationships between antral area, gut hormones and energy intake following a nutrient drink in healthy lean humans.

The aim of this study was to determine: (i) the effects of varying the inter-meal interval on subsequent energy intake, and (ii) temporal relationships between postprandial changes in antral area and gastrointestinal hormone concentrations with energy intake. 16 healthy lean participants (10 M, 6 F) were studied on 4 occasions in randomized fashion. Participants consumed 500ml of water 180min ("control"), or 500ml of a mixed-nutrient drink (750kcal) 30 ("EI-30"), 90 ("EI-90") or 180 ("EI-180") min, prior to a cold, buffet-style meal, from which energy intake was quantified. Antral area was measured using 2D-ultrasound, perceptions of hunger and fullness were scored using visual analogue scales, and blood samples collected at regular intervals for analysis of plasma cholecystokinin (CCK), peptide YY (PYY) and ghrelin concentrations. All nutrient drinks increased antral area, stimulated CCK and PYY, and suppressed ghrelin and energy intake (EI-30: -367±69, EI-90: -291±69, EI-180: -219±72kcal, P<0.05, for all), compared with control. Energy intake was related directly to the length of the inter-meal interval (R=0.33, P<0.01), such that as the inter-meal interval increased, energy intake increased. There was a strong relationship between antral area (R=-0.76, P<0.001), and weaker relationships between CCK (R=-0.36, P<0.01) and PYY (R=-0.34, P<0.01), with the inter-meal interval. In conclusion, energy intake increased as the inter-meal interval increased. This was associated with temporal changes in gastric content (antral area) and plasma gut hormone concentrations.

Ultrasonographic evaluation of gastric content during labour under epidural analgesia: a prospective cohort study.

BACKGROUND: Women in labour are considered at risk of gastric content aspiration partly because the stomach remains full before delivery. Ultrasonographic measurement of antral cross-sectional area (CSA) is a validated method of gastric content assessment. Our aim was to determine gastric content volume and its changes in parturients during labour under epidural analgesia using bedside ultrasonography. METHODS: The cut-off value corresponding to an increased gastric content was determined by ultrasound measurement of antral CSA in six pregnant women in late pregnancy before and after ingestion of 250 ml of non-clear liquid. Antral CSA was then measured twice in 60 parturients who presented in spontaneous labour: when the anaesthesiologist was called for epidural analgesia catheter placement, and at full cervical dilatation. Patient-controlled epidural analgesia was performed with a solution of ropivacaine and sufentanil. RESULTS: After liquid ingestion, antral CSA (mm(2)) increased from 90 (range, 80-151) to 409 (range, 317-463). A CSA of 320 was taken as cut-off value. The feasibility rate of antral CSA determination was 96%. CSA decreased from 319 [Q1 158-Q3 469] to 203 [Q1 123-Q3 261] during labour (P=2×10(-7)). CSA was >320 in 50% of parturients at the beginning of labour vs 13% at full cervical dilatation (P=0.006). CONCLUSIONS: Bedside ultrasonographic antral CSA measurement is feasible in pregnant women during labour and easy to perform. The observed decrease in antral CSA during labour suggests that gastric motility is preserved under epidural anaesthesia. The procedure could be used to assess individual risk of gastric content aspiration during labour.

Postprandial proximal gastric acid pocket in patients after distal gastrectomy.

BACKGROUND: An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in the majority of normal individuals and patients with gastroesophageal reflux disease. The role of gastric anatomy, specifically the antrum, in the physiology of the PPGAP is not yet fully elucidated. This study aims to analyze the presence of PPGAP in patients submitted to distal gastrectomy. METHODS: A total of 15 patients who had a distal gastrectomy plus DII lymphadenectomy and Roux-en-Y reconstruction for gastric adenocarcinoma (mean age 64.3±8.4 years, 12 females) were studied. All patients were free of foregut symptoms after the operation. Patients underwent a high-resolution manometry. A station pull-through pH monitoring was performed from 5cm below the lower border of the lower esophageal sphincter (LBLES) to the LBLES in increments of 1cm in a fasting state and 10min after a standardized fatty meal. Postprandial proximal gastric acid pocket was defined by the presence of acid reading (pH<4) in a segment of the proximal stomach between non-acid segments distally (food) and proximally (LBLES). The PPGAP extent was recorded. The protocol was approved by local ethics committee. Key Results Acidity was not detected in the stomach of nine patients before meal. After meal, PPGAP was not found in three patients. In three patients (20%), a PPGAP was noted with an extension of 1, 1 and 3cm. CONCLUSIONS & INFERENCES: In conclusion, PPGAP is present in a minority of patients after distal gastrectomy; this finding may suggest that the gastric antrum may play a role in the genesis of the PPGAP.

Clinical assessment of the ultrasonographic measurement of antral area for estimating preoperative gastric content and volume.

BACKGROUND: This prospective observational study aimed to assess the feasibility and performance of the ultrasonographic measurement of antral cross-sectional area (CSA) for the preoperative assessment of gastric contents and volume in adult patients and for the diagnosis of risk stomach (defined by the presence of solid particles and/or gastric fluid volume >0.8 ml/kg). METHODS: A preoperative ultrasonographic measurement of the antral CSA was performed for each patient by a physician (L.B.) blinded to the history of the patient. Immediately after tracheal intubation, an 18-French multiorifice Salem tube was inserted and gastric contents were aspirated in five different patient positions; during this time, the patient's epigastrium was massaged and the tube was moved backward and forward in the stomach. The relationship between the antral area and the volume of aspirated gastric contents was analyzed, as was the performance of ultrasonographic measurement of antral area for the diagnosis of risk stomach. RESULTS: The measurement of antral CSA was performed on 180 of 183 patients. A significant positive relationship between antral CSA and aspirated fluid volume was found. The cutoff value of antral CSA of 340 mm(2) for the diagnosis of risk stomach was associated with a sensitivity of 91% and a specificity of 71%. The area under the receiver operating characteristic curve for the diagnosis of risk stomach was 90%. CONCLUSIONS: The ultrasonographic measurement of antral CSA could be an important help for the anesthesiologist in minimizing the risk of pulmonary aspiration of gastric contents due to general anesthesia.

Variabilities of gallbladder contraction indices and a simple regression model for gallbladder and gastric emptying ratio.

INTRODUCTION: The objective of this study was to assess the variabilities of gallbladder contraction indices (GBCI) and derive a predictive model for gallbladder and gastric motility. METHODS: The gallbladder volume and gastric antral measurements were obtained from 24 healthy male volunteers in preprandial and post-milk ingestion states. After preprandial measurement of the gallbladder volume and gastric antral area, each subject ingested 157 ml of full cream milk and 30 cl of ion-free water. In supine position, the gallbladder volume and the gastric antral area were obtained every five minutes for 40 minutes. For the gallbladder while only the 5(th), 10(th) and 15(th) measurement of gastric antral area were obtained. Gallbladder contraction indices were calculated and gastric emptying ratio obtained at the fifteenth minute is the indication of gastric motility. Statistical analyses were conducted using SPSS version 16.0 with p < 0.05 as criterion of statistical significance. RESULTS: The GBCIs followed Gaussian response at some stages and did not at some other stages. The least variability occurred at the 35th measurement of GBCI. A cut- off value for the 35th minute GBCI value was established with the mean ± 2 SD (80.79 ± 11.5%). Obvious gallbladder refilling was noted after 35 minutes. A positive relationship was noted between gallbladder and gastric motilities. CONCLUSION: With milk dilution, the variability of gall bladder motility is least at the 35th minute. A significant positive relationship between gastric emptying and gallbladder contraction index was also observed.

Anatomía e histología de los ciegos pilóricos en cinco especies de peces de la familia characidae / Anatomy and histology of the pyloric caeca in five species of fish of the characidae family

Se realizaron análisis macro y microscópicos de los ciegos pilóricos en las especies Mylossoma acanthogaster, M. duriventre, M. aureum, Pygocentrus cariba y Cynopotamus venezuelae, procedentes de los ríos Catatumbo, Orinoco, Apure y Cunaviche en Venezuela. P. cariba presentó mayor número ciegos pilóricos oscilando entre 14 a 34. Las especies de Mylossoma mostraron un número intermedio, mientras que el menor número se observó en C. venezuelae, con 9 a 11 ciegos. Partiendo desde el lumen hacia la capa más externa, la mucosa está constituida por pliegues largos y profundos revestidos de tejido epitelial cilíndrico simple con células caliciformes y chapa estriada; la submucosa está conformada por tejido conjuntivo laxo; la muscular está dispuesta en tres estratos de fibras musculares, excepto en M. aureum, la cual posee dos estratos y la serosa por un epitelio plano simple. La histomorfología de los ciegos pilóricos de estas especies es similar a la de la mayoría de los peces teleósteos.

Macro and microscopy analyzes on the pyloric caeca of the species Mylossoma acanthogaster, M. duriventre, M. aureum, Pygocentrus cariba and Cynopotamus venezuelae were performed. The specimens were captured in locations of the Catatumbo, Orinoco, Apure and Cunaviche rivers in Venezuela. P. cariba showed the bigger number of pyloric caeca varying with number from 14 to 34; the other studied species had a number in between, while C. venezuelae showed the smaller number varying from 9 to 11 caeca. Histologically from the lumen to the most external layer, the mucosa is formed by long and deep folds covered by single cylindrical epithelial tissue with caliciform cells, striated sheets; the submucosa is conformed by lax conjunctive tissue; the musculature consists of three strata of muscular fibers, except in M. aureum which has only two strata and the serous formed by a simple epithelial plane. The histomorphology of the pyloric caeca of these species is similar to that of the majority of teleosts.

Effects of clonidine and sumatriptan on postprandial gastric volume response, antral contraction waves and emptying: an MRI study.

Gastric emptying (GE) may be driven by tonic contraction of the stomach ('pressure pump') or antral contraction waves (ACW) ('peristaltic pump'). The mechanism underlying GE was studied by contrasting the effects of clonidine (alpha(2)-adrenergic agonist) and sumatriptan (5-HT(1) agonist) on gastric function. Magnetic resonance imaging provided non-invasive assessment of gastric volume responses, ACW and GE in nine healthy volunteers. Investigations were performed in the right decubitus position after ingestion of 500 mL of 10% glucose (200 kcal) under placebo [0.9% NaCl intravenous (IV) and subcutaneous (SC)], clonidine [0.01 mg min(-1) IV, max 0.1 mg (placebo SC)] or sumatriptan [6 mg SC (placebo IV)]. Total gastric volume (TGV) and gastric content volume (GCV) were assessed every 5 min for 90 min, interspersed with dynamic scan sequences to measure ACW activity. During gastric filling, TGV increased with GCV indicating that meal volume dictates initial relaxation. Gastric contents volume continued to increase over the early postprandial period due to gastric secretion surpassing initial gastric emptying. Clonidine diminished this early increase in GCV, reduced gastric relaxation, decreased ACW frequency compared with placebo. Gastric emptying (GE) rate increased. Sumatriptan had no effect on initial GCV, but prolonged gastric relaxation and disrupted ACW activity. Gastric emptying was delayed. There was a negative correlation between gastric relaxation and GE rate (r(2 )=49%, P < 0.001), whereas the association between ACW frequency and GE rate was inconsistent and weak (r2=15%, P = 0.05). These findings support the hypothesis that nutrient liquid emptying is primarily driven by the 'pressure pump' mechanism.

Theophylline and gastric emptying in very low birthweight neonates: a randomised controlled trial.

BACKGROUND: Theophylline treatment causes side effects such as tachycardia, hyperglycaemia, abdominal distension, and vomiting. The latter two are probably the result of delayed gastric evacuation. OBJECTIVE: To study the effect of theophylline on gastric emptying time in preterm infants. PATIENTS: The subjects were 18 premature neonates with a mean (SD) birth weight of 1302 (240) g and a mean (SD) gestational age of 28.7 (1.9) weeks. MAIN OUTCOME MEASURES: In each case, gastric emptying was measured on two occasions: once when the newborns were being treated with theophylline and once when they were not. Half of the cases were randomised to receive theophylline before the initial measurement. The opposite was applied for the rest. Gastric emptying was assessed ultrasonically by measuring the change in antral cross sectional area (ACSA) at regular intervals over 120 minutes. RESULTS: The mean (SD) ACSA half time in the newborns receiving theophylline was 52 (19) minutes compared with 37 (16) minutes in those not receiving theophylline. This difference is significant (p < 0.05). CONCLUSIONS: Treatment with theophylline seems to delay gastric emptying in very low birthweight neonates, and this must be taken into consideration when this drug is used to treat apnoea of prematurity.

A gradient of TFF3 (trefoil factor family 3) peptide synthesis within the normal human gastric mucosa.

TFF3 is a member of the trefoil factor family (TFF) peptides, which enhance the surface integrity of mucous epithelia, and is typically secreted by intestinal goblet cells together with the mucin MUC2. Reports of the expression of TFF3 within the normal human stomach are contradictory and the precise localisation of TFF3 is unknown. We have mapped the human gastric mucosa by reverse transcription/polymerase chain reaction and Western blot analysis and by immunohistochemistry. Small amounts of TFF3 were detectable in the oxyntic mucosa of the corpus, whereas TFF3 synthesis increased sharply distal to the corpus-antrum transitional zone. TFF3 secretion was demonstrated in the antrum, the pyloric region and the proximal duodenum. High TFF1 levels were present in all regions of the gastric mucosa including the corpus, whereas the proximal duodenum was nearly devoid of TFF1. Immunohistochemistry localised TFF3 to antral and pyloric surface mucous cells. In the antrum, an increasing concentration gradient was found towards cells deeper in the isthmus. TFF1 was confined to superficial pit cells in the antrum. TFF3 was also present in specific layers of the laminated mucous gel of the antral and pyloric regions and variable concentrations of TFF3 (2-62 nmol/l) were measured in gastric juice. Here, a probably N-terminally shortened variant is present that forms disulphide-linked dimers. Thus, TFF3 is a typical secretory peptide of the normal human antral and pyloric gastric mucosa and has a gastric expression pattern different from that of TFF1 and TFF2. TFF3 might therefore have important physiological functions in the stomach, e.g. as a luminal surveillance peptide maintaining particularly the integrity of the antral and pyloric mucosa.

Wall thickening of the gastric antrum as a normal finding: multidetector CT with cadaveric comparison.

OBJECTIVE: The purpose of this study was to establish the normal range of wall thickness and the normal appearance of the gastric antrum on multidetector CT (MDCT). METHODS: AND MATERIALS. Soft-copy measurements of the gastric antrum and gastric body were performed on contrast-enhanced MDCT scans in 153 consecutive patients without gastric disease. For comparison, anatomic dissection of the stomach was performed in three cadavers. RESULTS: Smooth thickening of the distal gastric antrum relative to the proximal stomach on MDCT was seen in 152 (99%) of 153 patients and appeared concentric in 96% and eccentric in 4%. The mean (+/- SD) antral wall thickness was 5.1 +/- 1.6 mm. The longitudinal extent of antral wall thickening averaged 4.6 cm. At least one antral wall measurement (anterior or posterior) exceeded 5 and 10 mm in 85 patients (56%) and seven patients (5%), respectively. The anterior wall of the gastric body was significantly thinner at 2.0 +/- 0.4 mm (mean +/- SD) than the wall of the gastric antrum (p << 0.0001). The mean antral wall thickness when distention was characterized as grade 1 (least), 2, 3, and 4 (most) was 6.9, 5.1, 4.9, and 4.0 mm, respectively. Linear submucosal low attenuation (mural striation) of the thickened portion of the gastric antrum was noted in 36 patients (24%); fat attenuation was present in 14 cases. Cadaveric stomachs showed mild segmental thickening of the distal gastric antrum, but this thickening was less pronounced compared with in vivo MDCT findings. CONCLUSION: Smooth wall thickening of the distal gastric antrum relative to the proximal stomach on MDCT with or without submucosal low attenuation is a normal finding. Antral wall thickness commonly exceeds 5 mm and may measure up to 12 mm. Our MDCT findings, in conjunction with previous anatomic and physiologic observations, suggest that normal antral wall thickening consists of both static and dynamic components.

[Clinical anatomy of gastroduodenal transition]. / Klinicheskaia anatomiia gastroduodenal'nogo perekhoda.

Individual differences of gastroduodenal transition shape, dimensions and structure were studied using histo-topographic preparations from 45 human cadavers, 60 intravital X-ray photographs and findings from 55 endoscopic examinations. The range of differences in the position of gastroduodenal mucosal junction on pyloric duodenal and gastric surfaces, was established. Muscular, muscular-submucosal and muscular-glandular types of gastroduodenal transition were distinguished. The morphological parameters of the differences of pyloric wall shape and dimensions were defined. Endoscopically, the dimension of pyloric orifice was classified as small, medium and large while its shape was described as round, oval, triangular or polygonal. Clinical applications of the data obtained were determined. Gastroduodenal transition is described as a complex, individually variable anatomical structure with clinically significant differences of its major structural components.

Morphological examination of the termination pattern of substance P-immunoreactive nerve fibers in human antral mucosa.

The termination pattern of substance P (SP)-containing axons in human antral mucosa was examined using immunohistochemical techniques at the light and electron microscopic level. SP-immunoreactive (IR) axons were found to extend towards the pit region of the glands, where intraepithelial axons were observed. Electron microscopy showed immunostained axon profiles in close contact with the basement membrane of surface mucous cells. Membrane-to-membrane contacts between labeled axons and myofibroblast-like cells were identified, and SP-IR axons that were apposed to the epithelium were also in contact with subjacent myofibroblast-like cells. The anatomical relationship between SP-IR axons and the cells of the muscularis mucosae was investigated by light microscopy. Immunoreactivity for alpha-smooth muscle actin (alpha-sma) was used to visualize the smooth muscle cells, and the alpha-sma-IR cells were found to create a network that surrounded the gastric glands. Immunostained varicose axons ran alongside and in close apposition to the labeled muscle strands. Ultrastructural examination showed close contacts between SP-IR axon profiles and smooth muscle-like cells. In conclusion, SP-containing neurons may be important for sensory and secretomotor functions in the human antral mucosa.

[MR imaging of gastric wall layers in vitro: correlation to thehistologic wall structure]. / Experimentelle Darstellung der Schichten der Magenwand mittels MRT: Korrelation mit demhistologischen Wandaufbau.

PURPOSE: To correlate gastric wall layers visible of MRI with the anatomical structure of the gastric wall. METHODS: After macroscopic preparation 5 x 5 cm post-mortem tissue sections of the gastric antrum were evaluated using a 2.4 Tesla MR unit (Bruker, Ettlingen, Germany). MR imaging consisted of T2-weighted multi-spinecho sequences in longitudinal and axial directions. The specimens then were stained with hematoxylin-eosin for histological examination. After that histological correlation of the gastric wall layers visible on MRI was performed. RESULTS: In all specimens four gastric wall layers could be clearly identified on MRI. The direct comparison of those layers to the histological findings showed the following correlation: 1) intermediate signal = mucosa, 2) hypointense signal = lamina muscularis mucosae, 3) hyperintense signal = submucosa, 4) intermediate signal = muscularis propria. CONCLUSIONS: Gastric wall layers visible on MRI were successfully correlated to the anatomic layers of the gastric wall. This allows us for the first time to classify invasion of gastric carcinoma using high spatial-resolution MR imaging. However, the subserosa and serosa are excluded from this conclusion, because so far a reliable statement concerning the value of MRI to depict these very variable layers is not possible.

Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection.

BACKGROUND AND AIMS: The aim of this study was to clarify the endoscopic features of the Helicobacter pylori (H. pylori)-free stomach by examining the arrangement of minute points visible on the corpus. Since these points were clarified by magnifying endoscopy as collecting venules, this finding was termed 'regular arrangement of collecting venules (RAC)'. The findings from more endoscopic studies are presented and the differences between magnified views of the normal and H. pylori-infected corpus and antrum are described in particular. METHODS: The study group consisted of 557 patients who were subjected to endoscopy and checked for H. pylori. The RAC in each patient was assessed. Magnifying endoscopy in 301 patients was used to examine the corpus and in 94 patients to examine the antrum. RESULTS: One hundred and fifty-eight patients had normal stomachs without H. pylori. We diagnosed 389 patients with H. pylori gastritis. In 10 patients H. pylori was not detected, but inflammation was present. Of the 158 patients with H. pylori-negative normal stomachs, 151 had RAC. As a determinant of the normal stomach without H. pylori infection, the presence of RAC had 93.8% sensitivity and 96.2% specificity. All 30 patients with H. pylori-negative normal stomachs had a well-defined ridge pattern (wDRP) on the antrum as observed under magnifying endoscopy. As a determinant of the normal stomach without H. pylori infection, wDRP had a specificity of 100%, but a sensitivity of only 54.5%. CONCLUSIONS: The presence of RAC is characteristic of a normal stomach without H. pylori. Magnified views of the normal antrum were different from that of the normal corpus.